Patient Blogs | Psoriatic Arthritis
My Psoriatic Arthritis Diagnosis Story
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In 1976, I attended a law firm retreat at a resort, where I participated in a tennis tournament. I self-selected the “B” level, and I won all of my games, so I was elevated to the “A” level. After two sets, my left knee started to swell due to what I assumed was overplay, so I quit the game and limped off the court. I went to my room, iced my knee, and lay down.

On the following Monday, I went to an orthopedic surgeon, who took X-rays of my knee and determined that I did not have an orthopedic issue, but he referred me to a rheumatologist for an evaluation.

The rheumatologist examined the swollen knee but also saw psoriatic lesions on my arms and thighs and pitting in my fingernails. He drained the knee, reviewed the X-rays, and took blood tests. At my next office visit, he had the results from the blood test, which provided a negative confirmation that I did not have the Rh factor (which would have been an indicator for rheumatoid arthritis). So, in light of the lesions, pitting, and knee issues, he diagnosed psoriatic arthritis (PsA), which he described as “traumatically induced.”

During the first year of PsA treatment by the rheumatologist, I began to also have pain in my neck. X-rays revealed the early onset of psoriatic spondylarthritis (arthritis of the spine) in my neck, limiting my ability to nod up and down and move my head from side to side.

Up until this time (late 1970s), I had been relatively active, playing tennis and volleyball. After the tennis incident, the swollen knee subsided, and I returned to normal activities, but at a more moderate level and less frequently. Little did I know or anticipate that, over time, I would develop a severe case of PsA, requiring multiple joint replacements between 1999 and 2018.

Beginning in the late 1970s and continuing into the 1980s and 1990s, despite limited physical activity, I began to notice pain and swelling in my knees, ankles, and metatarsal arches (balls of the feet). I would wear over-the-counter braces and supports, and I started to use orthotics in my shoes as prescribed by my rheumatologist.

My son was born in 1972, and when he was old enough to play catch with a baseball or football, it saddened me to understand that I could no longer throw a ball overhand. Imagine the frustration of this, from one with an above-average throwing arm who had typically played outfielder or quarterback in my teens. Physical limitations, which also had an emotional effect, had begun in earnest.

In 1996, I was getting into bed late one night when my left knee locked at a 90-degree angle. Neither heat nor ice worked to release the lock. The pain was excruciating. My wife frantically called my rheumatologist, who prescribed intense pain mediation and said that if the pain and locked knee did not normalize in the morning, he would order an ambulance to take me to the hospital.

The locked knee would not give. This was a horrendous situation. An ambulance arrived at the house and the attendants carried me downstairs and drove me to the hospital. My physician arranged for an orthopedist to perform an urgent surgery that afternoon. He repaired my meniscus arthroscopically and then removed some of the excess synovial lining around that knee. During my follow-up visit to his office a few days later, he took X-rays of both knees and both hips, and gave me the distressing prognosis that damage and destruction of all four of those joints was such that I would likely require total joint replacement surgery in the future.

This was extremely upsetting news to digest. Although he was a good surgeon, he was abrupt and arrogant. I learned the importance of identifying physicians who were good listeners, with excellent qualifications and a reassuring bedside manner.

If I had been diagnosed with PsA after 1999, and if I had been placed on a biologic drug at that time, I probably would not have had to undergo six total replacement surgeries (knees, hips, and shoulders). Hope for the future for younger PSA patients will come from early diagnosis and treatment. I know from reviewing materials from the American Joint Replacement Registry that the introduction of biologic drugs has greatly reduced the number of joint replacements for rheumatoid-like patients (which includes PsA patients).

It is critical that a PsA patient is proactive in seeking treatments and is their best advocate for health care.

Stay connected to others with PsA. Join our Facebook Support Group now. 



Photo Credit: gilaxia / E+ via Getty Images

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Richard Seiden

Richard Seiden

Diagnosed since 1976

Richard Seiden has lived with psoriasis and psoriatic arthritis for 50 years. A retired attorney whose practice focused on representing providers in the health care industry, he is spending retirement as a board or panel member on several nonprofit health care organizations and a National Institutes of Health panel. In addition, he is a patient advocate and educational resource for other patients based on his disease experience. He is also a longtime board member of the National Psoriasis Foundation. He lives in Southern California.

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